Albuminuria Not Always Seen in Renal Disease

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

This cross-sectional Swedish study of type 2 diabetics found that 20% had chronic kidney disease of stage 3-5.

Be aware that the American Diabetes Association recommends screening all diabetics for CKD with serum creatinine and urinary protein measurement.

BARCELONA -- Even when macro albuminuria is not observed in a diabetic patient, it is not a guarantee that the patient is free of advanced chronic kidney disease, researchers reported here.

"We only found that 5% of our patients with stage 3-5 kidney disease had macro albuminuria," said Lars Weiss, MD, PhD, associate professor of nephrology at Karlstad Central Hospital in Sweden, "yet 20% of our patients had reduced renal function."

In his poster presentation at the annual meeting of the European Association for the Study of Diabetes, Weiss told MedPage Today, "We think that all patients with a history of diabetes should be tested for glomerular filtration rate (GFR) even if they do not show macro albuminuria in their urine tests."

Weiss reported on results of the Prevalence of Renal Impairment in Diabetes (PRIDE) study. He and colleagues in Sweden enrolled 588 type 2 diabetes patients from 53 primary care centers. The trial was limited to patients with at least one year's duration of diabetes who were at least 40 years of age. The presence of albuminuria was measured by urinary albumin-creatinine ratio. The prevalence of chronic kidney disease was determined based on the presence of albuminuria and decreased estimated GFR measured according to the Modification of Diet in Renal Disease.

Of the 588 patients in the trial, albuminuria was detected in 155 patients -- about 26% -- with micro-albuminuria seen in 128 (22%) of patients and macro albuminuria observed in just 27 patients (5%), the researchers reported.

However, 220 patients were diagnosed with stage 1-5 chronic kidney disease. Of those patients, 105 (16% of the total cohort) were diagnosed with stage 1-2 chronic kidney disease, while 115 (20% of the total cohort) were diagnosed with stage 3-5 chronic kidney disease -- all having GFR rates of less than 60 mL/min/1.73 m2.

"Our finding of a 20% prevalence of advanced chronic kidney disease is virtually the same as has been found in the general population of Swedish patients with diabetes," Weiss noted, suggesting that his findings were generalizable to the greater population.

"The occurrence of chronic kidney disease, as measured by the presence of significantly decreased GFR with or without albuminuria, is common in Swedish type 2 diabetes patients treated in primary care," Weiss said. "It is not enough just to observe albuminuria and assume the patient who is free of macro albuminuria is free of chronic kidney disease. You have to do the estimated GFR test as well in patients with type 2 diabetes."

The snapshot of patients with type 2 diabetes also determined:

The odds ratio for patients with chronic kidney disease stage 3-5 for being diagnosed with retinopathy was 2.71 (95% CI 1.14-6.25, P=0.02) when compared with patients in chronic kidney disease stage 0-2.

Weiss also reported that the prevalence of vascular disease and ischemic stroke occurred more frequently in patients with chronic kidney disease stage 3-5 than in patients in chronic kidney disease stage 0-2.

"Professor Weiss has taught us that we must check the estimated GFR in our patients with type 2 diabetes, and not just rely on macro albuminuria," Lars Sarhammar, MD, a private practice physician in Karlstad, told MedPage Today. Sarhammar was not involved in the study.

The study was sponsored by Boehringer Ingelheim.

Weiss had no other disclosures. Sarhammar had no disclosures.

Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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